intracranial haemorrhage

Question 1

what are the 3 main types of intracerebral haemorrhage

Answer 1

supratentorial, infratentorial, intraventricular

Question 2

what is the most common cause of primary intracerebral haemorrhage

Answer 2

hypertension

Question 3

name some causes of secondary intracerebral haemorrhage

Answer 3

AV malformations, aneurysms, dural venous thrombosis

Question 4

how does malignant hypertension cause intracerebral haemorrhage

Answer 4

acute severe HTN, causing rupture of previously unaffected artery

Question 5

focal symptoms of an intracerebral haemorrhage

Answer 5

paresis, dysphasia, numbness, seizure, visual symptoms, dyscoordination

Question 6

global symptoms of an intracerebral haemorrhage

Answer 6

headache N+V, reduced GCS, pupils

Question 7

what is the most common cause of a subarachnoid haemorrhage

Answer 7

berry aneurysm

Question 8

thunderclap headache

Answer 8

subarachnoid haemorrhage

Question 9

where is a thunderclap headache most commonly felt

Answer 9

occipital - like being hit on the back of the head

Question 10

what is a subarachnoid haemorrhage

Answer 10

bleeding between the pia mater and the arachnoid membrane (subarachnoid space)

Question 11

investigation for a subarachnoid haemorrhage

Answer 11

CT - irregular shaped bleed, hyper-attenuation in the subarachnoid space

Question 12

what can you do if there’s a negative CT scan in a suspected subarachnoid haemorrhage and what is a positive result

Answer 12

lumbar puncture: presence of blood or xanthocromia

Question 13

what is xanthocromia

Answer 13

yellowing of CSF due to haemolysis of an older subarachnoid bleed

Question 14

medical management of a subarachnoid haemorrhage

Answer 14

nimodipine - prevent delayed cerebral ischaemia caused by vasospasm

Question 15

management of subarachnoid haemorrhage caused by aneurysm

Answer 15

endovascular coiling

Question 16

what can be used to detect aneurysms in the brain

Answer 16

CT angiography

Question 17

what usually causes a subdural haematoma

Answer 17

trauma causing damage to one of the bridging veins

Question 18

what is a subdural haematoma

Answer 18

collection of blood between the dura mater and the arachnoid mater

Question 19

who are the 2 groups of people who typically present with a subdural haematoma

Answer 19

patients following significant head trauma
elderly patients over 65

Question 20

why are older patients more at risk of a subdural haematoma

Answer 20

age related brain atrophy increases the tension on bridging veins making them more prone to rupture

Question 21

name some more risk factors for a chronic subdural haematoma

Answer 21

anticoagulant and antiplatelet therapy
alcohol related brain atrophy
bleeding disorders
chronic kidney disease due to platelet dysfunction

Question 22

clinical presentation of subdural haematoma

Answer 22

headache, N+V, confusion, behavioural change

Question 23

investigation for subdural haematoma and positive sign

Answer 23

head CT
crescent of blood around the brain tissue + midline shift

Question 24

what indicates the need for surgical management of a subdural haematoma

Answer 24

significant midline shift
cerebral oedema

Question 25

surgical management of an acute subdural haematoma

Answer 25

craniotomy

Question 26

surgical management of a chronic subdural haematoma

Answer 26

burr holes

Question 27

patient who is taking dabigatran (DOAC) has a subdural haematoma - what can you prescribe

Answer 27

idarucizumab

Question 28

what is an extradural haematoma

Answer 28

collection of blood between the dura mater and the inner surface of the skull

Question 29

what typically causes an extradural haemorrhage

Answer 29

fracture of temporal or parietal bone due to trauma

Question 30

most common vessel damaged in an extradural haematoma

Answer 30

middle meningeal artery

Question 31

classic clinical course seen in an extradural haematoma

Answer 31

brief LOC following initial injury period of apparent recovery (the lucid interval) subsequent deterioration with worsening symptoms and signs

Question 32

clinical signs of extradural haematoma

Answer 32

external injuries Cushing's triad of raised ICP: bradycardia, hypertension and irregular breathing 6th nerve palsy CSF otorrhoea or rhinorrhoea unequal pupils

Question 33

investigation for extradural haemorrhage and positive finding

Answer 33

non-contrast CT head biconvex (lens shaped) hyperdense extra-axial collection